CPT 13122 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XS - Separate Structure |
| Complexity Level | Low |
National average reimbursement for CPT 13122 by major payers:
$151.78
$162.87
$168.39
$208.06
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 13122 | ||||||
United | 13122 | $555.00 | 1295923670 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $574.00 | 1508942665 - THE ENDOSCOPY CENTER AT GATEWAY LLC | 272800486 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $1446.00 | 1902218456 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY AT INDEPENDENCE MEDICAL VILLAGE | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $330.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $567.00 | 1083613327 - BLOOMINGTON NORMAL HEALTHCARE, LLC | 371383015 - (IL) BLOOMINGTON-NORMAL HEALTHCARE, L.L.C. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $76.00 | 1033223367 - SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | 201379958 - (FL) SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $123.00 | 1437642857 - GEORGIA VASCULAR & VEIN CENTER | 822239594 - (GA) GEORGIA VASCULAR VEIN CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $153.00 | 1477108900 - CLEARWAY SURGERY CENTER OF CRESTVIEW, LLC | 842479344 - (FL) CLEARWAY SURGERY CENTER OF CRESTVIEW LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $566.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $1708.00 | 1649218009 - RIVER DRIVE SURGERY CENTER, LLC, RIVER DRIVE SURGERY AND LASER CENTER | 223672648 - (NJ) RIVER DRIVE SURGERY CENTER L L | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $150.00 | 1255894051 - NEW JERSEY INTERVENTIONAL ASSOCIATES LLC | 262178516 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $230.75 | 1982818571 - RICHARD JOSEPH | 350593390 - DEACONESS HOSPITAL INC | IL | Emergency Medicine Physician (207P00000X) |
United | 13122 | $90.00 | 1538635859 - SEARCY AMBULATORY SURGERY CENTER LLC | 830756271 - (AR) SEARCY AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $75.00 | 1376886887 - REEVES EYE SURGERY CENTER LLC | 455006590 - (TN) REEVES EYE SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 13122 | $594.00 | 1528142726 - GENORTHO, LLC, CROW VALLEY ORTHOPAEDIC SURGERY CENTER | 203406994 - (IA) GENORTHO LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 13122 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 13122 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 13122 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 12020-CPT | Moderate | Closure Superfic Wound Dehiscence |
| 13120-CPT | Moderate | Complx Rpr Sclp Arm Leg 1.1-2.5 Cm |
| 13121-CPT | Moderate | Rep Complex Scalp/Limb 2.5-7.5 Cm |
| 13122-CPT | Low | Repair, Complex, Scalp, Arms, And/Or Legs; Each Additional 5 Cm Or Less (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 13122. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 13122 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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